Does the cure for depression lie in counseling or in medication?

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Does the cure for depression lie in counseling or in medication? It depends. Some patients respond better to psychotherapy than medication — and vice versa — or prefer one type of treatment over another (Friedman, 2015).

Two-images collage depicting counseling and medications
Counseling vs. Medications

So, just as different people are affected differently by depression, there is no “one size fits all” treatment to cure depression. In fact, most of the time to even talk of “curing” depression is not entirely accurate. What happens in most cases is that after you have reduced the symptoms of an acute attack of depression, you may still need to continue giving maintenance doses of the medication to prevent a relapse.

There are two main approaches to treating depression: (1) Medications, and (2) Counseling or psychotherapy. In some, medications work well, and in others, you may need to try counseling. There is some evidence that combining psychotherapy and medications may be more effective than either treatment alone. There are a few cases where the depression is resistant to both these treatments, and then a third option is available to treat them, namely, brain stimulation therapies in the form of electroconvulsive therapy, transcranial magnetic stimulation, etc.

Medications to “Cure” Depression

According to a 2006 study funded by the National Institutes of Health, only about 30% of people with depression go into full remission after taking their first course of antidepressants. Those who got better were more likely to be taking slightly higher doses for longer periods (WebMD, 2019).

Antidepressant medicines are generally prescribed for six months to one year in the case of first-time depression. These medicines should be taken for at least 1-2 months before their full benefit sets in. Close monitoring during this period is necessary to determine the effectiveness of treatment and see if any side effects are developing. When you get better and without a relapse for at least several months, these medications may be tapered off. However, you may need a long-term periodic follow-up to check for any signs of depression recurrence or relapse (WebMD, 2018).

But, one should not rely on medications alone. Depression is not just about a chemical imbalance in the brain. Antidepressants may help relieve some of the symptoms of moderate and severe depression, but they don’t cure the underlying problem and are not usually suitable for long-term use because they have unwanted side effects. Counseling can be just as effective as medication, often even more so, but doesn’t come with unwanted side effects (Saisan, et al., 2019). However, sometimes long-term treatment with medications may be recommended to prevent further episodes of depression in people who have already suffered from two or more episodes of major depression (WebMD, 2018).

Counseling to ”Cure” Depression

When it comes to counseling for depression, there are three different therapies that are available for treating patients with depression. They are:

  1. Cognitive Behavioral Therapy
  2. Psychodynamic Therapy
  3. Interpersonal Psychotherapy

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of talk therapy in which your therapist makes you aware of your negative or false thoughts and helps you replace those thoughts with healthier and more realistic ones. You may need weeks or months of CBT before you start to feel better.

Treatment usually involves 10-20 sessions. Some may get therapy for more than a year. You may be given tasks to do at home. Towards the end of your CBT therapy, you will be shown skills that you can keep using to prevent your depression from recurring.

CBT often works as well or better than medications in the treatment of depression. CBT appears to have long-lasting effects in protecting against subsequent relapse and recurrence following the end of active treatment, something that cannot be said for medications. Even in severe cases of depression, it can be effective in the hands of a highly skilled therapist. In some patients, it works best when combined with medication. Research has shown that people who get CBT may be half as likely as those on medication alone to have depression again within a year (WebMD, 2018).

Psychodynamic Therapy

Psychodynamic therapy helps patients explore their feelings and emotions fully, both the conscious ones and the unconscious ones by bringing them to light during therapy. By lighting up their unconscious, it helps people understand how their unresolved issues and unconscious feelings from the past are driving their behavior and mood in the present.

The patient is encouraged to talk freely about whatever is on his or her mind. This uncovers the patterns of behavior and feelings that stem from past experiences and unrecognized feelings become apparent. Thus the patient can become more aware of how past experience and the unconscious mind are affecting his or her present life. Psychodynamic therapy can be long-drawn, duration varying from 16 to 20 weeks to more than a year.

A 2010 report published in the American Psychologist showed that psychodynamic therapy was at least as effective as other evidence-based therapies and that the benefits appeared to be longer-lasting (WebMD, 2018).

Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT) is focused on understanding and modifying certain processes or behaviors. IPT focuses on identifying issues and problems in interpersonal relationships and learning ways to address and improve them. It is a time-limited, short-term therapy. The emphasis is on learning new patterns rather than trying to analyze the causes of dysfunctional patterns.

A June 2011 study by Cujipers et al. published in Am J Psychiatry concludes that “There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with medications. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.”

Recent Advances

Recently we have been learning a lot about individual factors that might help predict a better response to one type of treatment over another.

A study by Callie l. McGrath et al. published in JAMA Psychiatry (McGrath, et al., 2013)  identified a potential biomarker in the brain that could predict whether a depressed patient would respond better to psychotherapy or antidepressant medication. They compared  SSRI antidepressant Lexapro to cognitive behavior therapy.

Overall, about 40 percent of the depressed subjects responded to either treatment. But they found striking brain differences between patients who did well with Lexapro compared with cognitive behavior therapy, and vice versa. Patients who had low activity in a brain region called the anterior insula measured before treatment responded quite well to CBT but poorly to Lexapro; conversely, those with high activity in this region had an excellent response to Lexapro, but did poorly with CBT (Friedman, 2015).

A large, multicenter study by Dr. Charles Nemeroff et al. found that for depressed adults without a history of abuse, Combined CBT and an antidepressant was superior to either treatment alone. But for those who had a history of childhood trauma, 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone (Friedman, 2015).

References

Friedman, R. A., 2015. To Treat Depression, Drugs or Therapy?. [Online]
Available at: https://well.blogs.nytimes.com/2015/01/08/to-treat-depression-drugs-or-therapy/
[Accessed 27 Sep 2019].

McGrath, C. L. et al., 2013. Toward a Neuroimaging Treatment Selection Biomarker for Major Depressive Disorder. JAMA Psychiatry, 70(8), pp. 821-829.

Saisan, J., Smith, M. & Segal, J., 2019. Depression Treatment. [Online]
Available at: https://www.helpguide.org/articles/depression/depression-treatment.htm
[Accessed 27 Sep 2019].

WebMD, 2018. Depression: Treating Depression With Medication. [Online]
Available at: https://www.webmd.com/depression/guide/treating-depression-medication#1
[Accessed 27 Sep 2019].

WebMD, 2018. Does Cognitive Behavioral Therapy Treat Depression?. [Online]
Available at: https://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression#1
[Accessed 27 Sep 2019].

WebMD, 2018. Psychodynamic Therapy for Depression. [Online]
Available at: https://www.webmd.com/depression/guide/psychodynamic-therapy-for-depression#1
[Accessed 27 Sep 2019].

WebMD, 2019. Depression Medicines. [Online]
Available at: https://www.webmd.com/depression/guide/optimizing-depression-medicines#1
[Accessed 27 Sep 2019].

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Does the cure for depression lie in counseling or in medication?
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Does the cure for depression lie in counseling or in medication?
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Does the cure for depression lie in counseling or in medication? It depends. Some patients respond better to psychotherapy than medication, and vice versa.
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DepressionPedia.org
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